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Search Results: 1 - 10 of 30659 matches for " Alex Sandro Rolland;Souza "
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Indica??o de cesarianas em óbito fetal
Sampaio, ?nderson Gon?alves;Souza, Alex Sandro Rolland;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010000400004
Abstract: purpose: to determine the factors associated with cesarean section in pregnancies with fetal death at a maternity hospital in recife, pernambuco, brazil. methods: a cross-sectional study was performed, which analyzed data from the information system about mortality and medical records, from january 2005 to december 2008, of hospital bar?o de lucena (hbl). we analyzed women with fetal death diagnosis, with gestational age of 20 weeks or more, in terms of sociodemographic characteristics, causes and types of fetal death, obstetrical precedents and birth characteristics. the associations between the variables were analyzed by the χ2 test of association and fisher exact test, with the level of significance set at 5%. we calculated the prevalence ratio as the measure of risk and the confidence interval (ci) at 95%. logistic regression analysis was also performed and the odds ratio (or) was calculated. results: among the 258 pregnant women with fetal death, 27.5% (n=71) underwent cesarean section. after multivariate analysis, the factors that remained significantly associated with cesarean section were maternal age below 20 years (or=0.23; 95%ci=0.06-0.85), history of one or more cesarean sections (or=7.02; 95%ci=2.29-21.55), multiple gestation (or=9.06; 95%ci=2.01-40.71), use of misoprostol for birth induction (or=0.07; 95%ci=0.01-0.32), fetal death occurring during birth (or=4.01; 95%ci=1.13-14.24), low birth weight (or=0.33; 95%ci=0.11-0.94), presence of hypertensive disorders (or=3.7; 95%ci=1.46-9.39) and abruptio placentae (or=13.9; 95%ci=4.67-41.69). conclusion: in hbl, the risk factors for cesarean section in pregnancies with fetal death were previous cesarean section, multiple gestation, intrapartum deaths, hypertensive disorders and abruptio placentae. the protective factors were teenage pregnancy, use of misoprostol and low birth weight.
Tratamento da pré-eclampsia baseado em evidências
Noronha Neto, Carlos;Souza, Alex Sandro Rolland de;Amorim, Melania Maria Ramos;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010000900008
Abstract: hypertensive disorders in pregnancy deserve special attention in the setting of global public health. currently, they represent the third cause of maternal mortality in the world and first in brazil. from a practical standpoint, pre-eclampsia remains a syndrome that leads to serious repercussions on maternal and fetal mortality and its etiology is not well known. currently, the best treatment for forms of pre-eclampsia is being discussed at different times in pregnancy and puerperium, with the objective to reduce the high rates of maternal and fetal morbidity and mortality. considering the pathophysiology of the event, anticipation of delivery is the best treatment for pre-eclampsia. the use of magnesium sulfate is recommended in all cases of severe pre-eclampsia and eclampsia for prevention and treatment of seizures. likewise, treatment of hypertensive crises is recommended. hydralazine, nifedipine and labetalol have been the most commonly used drugs for this purpose, but their use depends on the familiarity of the treating physician. antenatal corticoid therapy is indicated whenever there is an imminent risk of preterm delivery between 24 and 34 weeks. in contrast, there is insufficient evidence to recommend bed rest and routine plasma volume expansion, and there is an urgent need for randomized clinical trials to determine whether maintenance antihypertensive treatment in pregnant women has benefits or risks for mothers and fetuses in all clinical forms of disease, particularly in cases of pure pre-eclampsia.
Volume do líquido amniótico associado às anomalias fetais diagnosticadas em um centro de referência do nordeste brasileiro
Noronha Neto, Carlos;Souza, Alex Sandro Rolland;Moraes Filho, Olímpio Barbosa;Noronha, Adriana Mota Bione;
Revista Brasileira de Ginecologia e Obstetrícia , 2009, DOI: 10.1590/S0100-72032009000400002
Abstract: purpose: to determine factors associated to amniotic fluid volume and frequencies of fetal anomalies, in a reference center in pernambuco. methods: a transversal study performed in high-risk pregnant women submitted to obstetrical morphological ultrasound, from march 2002 to march 2006, at an institution from recife, pernambuco, brasil. the intrauterine diagnosis was confirmed after birth. sociodemographic and obstetrical characteristics, amniotic liquid volume and presence of fetal anomalies were the variables studied. fisher's exact, χ2, and student's t tests, at a significance level of 5% were applied to verify the correlation among the variables. prevalence rate and confidence interval at 95% were calculated. multiple logistic regression analysis was performed at a significance level of 5%. results: two hundred and fifty-seven pregnant women (56.2%) with congenital anomalies and 200 (43.8%) without anomalies, confirmed in the postnatal, were included in the study. the average of maternal ages and gestation periods were 24.8±6.5 years and 35.9±3.7 weeks, respectively. the fetal anomalies were discovered in the central nervous system (50.6%) and genitourinary tract (23.0%). the presence of congenital anomalies were significantly linked with reduced liquid/oligohydramnios (p=0.0002) and increased liquid/polyhydramnios (p<0.0001). intrauterine mortality was more frequent in the group with anomalies, as compared to the healthy fetuses (10.5 versus 2.5%; p<0.01). conclusions: the rate of congenital anomalies in the high-risk pregnant women group was 56.2%. most of the central nervous system malformations were diagnosed intrauterus. changes in the amniotic fluid were the factors more strongly associated with congenital anomalies.
Fatores associados à indu??o do parto em gestantes com óbito fetal após a 20a semana
Sampaio, ?nderson Gon?alves;Souza, Alex Sandro Rolland;Noronha Neto, Carlos;
Revista Brasileira de Saúde Materno Infantil , 2011, DOI: 10.1590/S1519-38292011000200003
Abstract: objectives: to determine the factors associated with induced delivery in pregnant women carrying a dead fetus. methods: a cross-sectional study with 258 pregnant women past the 20th week of gestation diagnosed by ultrasound as carrying a dead fetus, between january 2005 and december 2008, at the hospital bar?o de lucena maternity hospital, in recife, brazil. socio-demographic characteristics, causes and types of fetal death, prior obstetric data and characteristics of birth were the variables studied. the chi-square test, fisher's exact test and student's t test were used. the rate of prevalence was calculated and multiple logistic regression was carried out. the level of significance was 5%. results: birth was induced in 83 (32.2%) of the pregnant women. following multivariate analysis, it was found that a gestational age of over 40 weeks (or= 126.5; ci95%= 3.83-4,201.5) and late fetal death (or= 6.86; ci95%= 2.55-18.47) were the risk factors that continued to be associated with induced delivery. caesarian section (or= 0.02; ci95%= 0.004-0.09), funiculopathy (or= 0.12; ci95%= 0.02-0.68), having had one or more previous pregnancies (or= 0.34; ci95%= 0.14-0.81) and one or more previous caesarian sections (or= 0.16; ic95%= 0.04-0.71) were negatively associated with induced delivery. conclusions: a gestational age of over 40 weeks and late fetal death are the risk factors that could be associated with induced delivery in pregnant women carrying a dead fetus.
Mortalidade determinada por anomalias congênitas em Pernambuco, Brasil, de 1993 a 2003
Arruda, Tarciana Albuquerque Marenga de;Amorim, Melania Maria Ramos de;Souza, Alex Sandro Rolland;
Revista da Associa??o Médica Brasileira , 2008, DOI: 10.1590/S0104-42302008000200013
Abstract: background: to establish magnitude and temporal trend of deaths by congenital malformations in pernambuco state in northeast of brazil, from 1993 to 2003. methods: this is an observational descriptive study, with the temporal trend including all cases of death caused by congenital malformations, obtained from the database of the mortality information system of the ministry for health. results: from 1993 to 2003, 3.960 infant deaths and 989 stillbirths caused by congenital malformations were registered in pernambuco. the coefficients of fetal, early neonatal, perinatal, neonatal and infant (< 1 year) mortality were 0.57, 1.20, 1.76, 1.59 and 2.33, respectively. a rising tendency was observed in the temporal curve from 1993 to 2003 when coefficients of early neonatal (p = 0.003), perinatal (p = 0.005), neonatal (p = 0.0007) and infant (p = 0.02) mortality were studied but no statistical significance was detected for the fetal mortality coefficient (p= 0.55). conclusion: from 1993 to 2003 a rising tendency in the coefficients of early neonatal, perinatal, neonatal and infant mortality was found in the state of pernambuco. this trend may have been be influenced by an improvement in the death registration records and by a decline of infant mortality in the state of pernambuco.
Prevalência e fatores associados à prática da episiotomia em maternidade escola do Recife, Pernambuco, Brasil
Carvalho, Cynthia Coelho Medeiros de;Souza, Alex Sandro Rolland;Moraes Filho, Olímpio Barbosa;
Revista da Associa??o Médica Brasileira , 2010, DOI: 10.1590/S0104-42302010000300020
Abstract: objective: to determine the prevalence and factors associated with episiotomy in a reference center of pernambuco. methods: a retrospective cross-sectional study was carried out from january to december 2006 with 495 women who had a normal delivery at the maternity center monteiro de moraes integrated health amaury de medeiros (cisam) university of pernambuco. assciated factors were issues preceeding birth, characteristics of labor and perinatal outcome. to verify the association between predictors and performance of episiotomy the chi square, fisher's exact and student's t tests were used as appropriate, with a a significance level of 5%. the prevalence ratio and confidence intervals were calculated at 95%, in addition to logistic regression analysis. results: prevalence of performing episiotomy was 29.1% (n = 144). after bivariate analysis, we found a significant association of episiotomy with adolescence (pr 1.74. 95% ci 1.33-2.28), age over 35 years (pr 0.35. 95% ci 0.14-0.90), primiparity (pr 4.73, 95% ci 3.33-6.71), absence of previous vaginal delivery (pr 5.44, 95% ci 3.67-8.06) and related diseases at the time of delivery (rp 1.71, 95% ci 1.30-2.25). there was no significant relation with gestational age at delivery, duration of labor over 6h and expulsion period of more than 30 minutes, use of misoprostol or oxytocin, abnormal fetal heart rate, presence of meconium, shift of completion of delivery (night or day), rate of apgar score in 1 and 5 minutes and weight of the newborn. presence of perineal lacerations was higher in the group not subject to episiotomy, however only 1st and 2nd degree lacerations were described. after logistic regression, the analyzed remaining factors associated with episiotomies were maternal diseases (ra 1.99, 95% ci 1.20-3.28) and absence of previous vaginal delivery (9.85 ra, 95% ci 6.04-16.06). conclusion: prevalence of episiotomies in the institution was 29%. variables that remained related to episiotomy were maternal diseases
Concordancia entre citologia, colposcopia e histopatologia cervical
Katz, Letícia Maria Correia;Souza, Alex Sandro Rolland;Fittipaldi, Simone Oliveira;Santos, Gisele de Melo;Amorim, Melania Maria Ramos;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010000800002
Abstract: purpose: to evaluate the agreement between conventional cytology using the papanicolaou test, repeated at the time of colposcopy, with colposcopic and histopathological findings. methods: the study was carried out at the central public health laboratory of the state of pernambuco between january and july, 2008, involving 397 women referred for colposcopic evaluation following an abnormal cervical smear test. cytology was repeated at the time of colposcopy using conventional method, with particular attention being paid to the presence of abnormal colposcopic findings. the nomenclature used for cytology was the 2001 bethesda system terminology, while that used for histology was the world health organization 1994 classification. cytology performed at the time of colposcopy was compared with colposcopy and with histopathology obtained by colposcopy-directed biopsy. the kappa coefficient was used to evaluate the agreement between methods, as well as the χ2 test, with the level of significance set at 5%. results: poor agreement was found between cytology performed at the time of colposcopy and colposcopic findings (k=0.33; 95%ci=0.21-0.45) and between colposcopy and histopathology (k=0.35; 95%ci=0.39-0.51). cytology performed at the time of colposcopy compared with histopathology revealed a kappa of 0.41 (95%ci=0.29-0.530), which was considered to reflect moderate agreement. conclusions: agreement was better between cytology and histopathology than between colposcopy and cytology or between colposcopy and histopathology.
Efeito do sulfato de magnésio sobre o índice de pulsatilidade das artérias uterinas, umbilical e cerebral média fetal de acordo com a persistência da incisura protodiastólica da artéria uterina na pré-eclampsia grave
Souza, Alex Sandro Rolland;Amorim, Melania Maria Ramos;Santos, Roberta Espínola;Noronha Neto, Carlos;Porto, Ana Maria Feitosa;
Revista Brasileira de Ginecologia e Obstetrícia , 2009, DOI: 10.1590/S0100-72032009000200006
Abstract: purpose: to evaluate the effect of magnesium sulphate on the pulsatility index (pi) of the uterine, umbilical and fetal middle cerebral arteries, according to the persistency or not of the bilateral protodiastolic notch of the uterine arteries in severe pre-eclampsia. methods: a cohort study including 40 pregnant women with severe pre-eclampsia, 23 of them presenting bilateral protodiastolic notch, and 17, unilateral/absent notch. the patients were submitted to doppler velocimetry before and 20 minutes after the intravenous administration of 6 g of magnesium sulphate. the examination was carried out with the patient in semi-fowler position, the sonograms being obtained during fetal inactivity, in apnea and absent uterine contraction periods. all the exams were performed by two researchers, the average being considered as the final result. wilcoxon's test was used to compare the pi, before and after magnesium sulphate in both groups. the difference between the two measurements (before and after magnesium sulphate) was compared between the groups (bilateral incision and unilateral/absent incision) using the mann-whitney test. results: there was a significant increase in the maternal heart rate (mhr) and decrease in the maternal blood pressure, and in the pi medians of the two uterine arteries and in the fetal middle cerebral artery, after magnesium sulphate in both groups. there was a significant decrease in the pi of the left uterine artery and in the umbilical artery, only in the protodiastolic unilateral/absent notch group. nevertheless, it was not found any significant difference regarding the pi of the right uterine artery, or the cerebral/umbilical relationship, before and after magnesium sulphate in each group. no difference between the groups was found, before and after magnesium sulphate, for any of the studied outcomes. conclusions: after the intravenous administration of 6 g of magnesium sulphate to patients with severe pre-eclampsia, a decrease in blood pr
Valida??o do diagnóstico ultrassonográfico de anomalias fetais em centro de referência
Noronha Neto, Carlos;Souza, Alex Sandro Rolland de;Moraes Filho, Olímpio Barbosa de;Noronha, Adriana Mota Bione;
Revista da Associa??o Médica Brasileira , 2009, DOI: 10.1590/S0104-42302009000500016
Abstract: objective: to validate ultrasound diagnoses of fetal anomalies made in a fetal medicine center in pernambuco. methods: a cross sectional study was performed to validate the diagnosis test, including all high risk pregnant women submitted to obstetrical morphological ultrasound at the "instituto de medicina integral professor fernando figueira (i.m.i.p.)", from march 2002 to march 2006. prenatal diagnosis was confirmed after birth. socio demographic characteristics and pre and postnatal frequencies of fetal anomalies were the variables studied. agreement between pre and postnatal diagnoses from congenital anomalies were evaluated with the kappa indicator. youden's test was applied to validate prenatal ultrasound diagnoses. results: nine hundred and eighty nine patients were eligible. after evaluation of inclusion and exclusion criteria 457 patients were included in study. the average maternal age was 24.8 + 6.5 years. fetal anomaly diagnoses postnatal were confirmed in 257 (56.2%) pregnant women. prenatal ultrasound diagnosis of fetal anomalies disclosed 96% of sensibility and 79% of specificity, good agreement (k=0.76) between pre and postnatal diagnoses when compared to postnatal results and good diagnostic validity (y=0.75). conclusion: prenatal diagnoses of fetal anomalies at a fetal medicine center in pernambuco demonstrate good sensibility, specificity, agreement pre and postnatal and good diagnostic validity.
Diagnóstico pré-natal e parto transpelviano na osteogênese imperfeita: relato de caso
Souza, Alex Sandro Rolland de;Cardoso, Alexandre Silva;Lima, Marcelo Marques de Souza;Guerra, Gláucia Virgínia de Queiroz Lins;
Revista Brasileira de Ginecologia e Obstetrícia , 2006, DOI: 10.1590/S0100-72032006000400007
Abstract: osteogenesis imperfecta is a connective tissue disorder due to quantitative and qualitative anomalies in type 1 collagen, genetically transmitted by a dominant or recessive autosomal gene, leading to bone fragility. we report a case of a 19-year-old g1 po patient referred to our institution following a screening ultrasound that demonstrated short limb fetal extremities. a level 3 scan was performed which evidenced an irregular cranial shape and compression of the cephalic pole with moderate transducer pressure. limb shortening, decreased echoes and fractures of long bones were found on our scan evaluation. a vaginal delivery occurred at 35 weeks of gestation. the male newborn, weighing 1.990 grams had 6 and 8 in apgar scores. the neonate was clearly abnormal, presenting irregular cranial shape, with poor ossification on x-ray, blue sclera, fractures and limb deformities. postnatal evaluation was satisfactory and the neonate was discharged in good conditions. prenatal diagnosis is important for an adequate pregnancy follow-up. postnatal outcome was not related to vaginal delivery, as there were no recent fractures in the newborn.
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